Primary care can learn from health systems overseas, delegates told

PCNs can learn from health systems across the world to help tackle issues such as workforce and shifting care towards prevention, Pulse PCN delegates heard at an event in Manchester yesterday.

In a whistle-stop tour of 10 health systems around the world, Dr Dean Eggitt, chief executive of Doncaster LMC, highlighted that in health systems overseas GPs often act as the central figure running a team of nurses or community health workers to provide care where there are not enough doctors to go around.

He highlighted Rwanda, ‘does not have the health workforce they need to provide care’, Dr Eggitt’s research found.

‘They don’t have lots of highly trained doctors,’ he said. ‘What do you do [in this situation]? You will use people who are educated – not necessarily to the extent of a doctor – you will support them, you will help them, and they will be your eyes, ears and hands, while a doctor is simply a brain.’

In Rwanda, Dr Eggitt said these roles are called community health workers, but in England the equivalent would be care coordinators, care navigators or physician associates.

In Cuba, doctors oversee a ‘huge number of nurses’ as part of a drive towards tackling social determinants of health.

‘Cuba is absolutely wonderful because it really cares about improving people’s social wellbeing which then improves their healthcare outcomes. And it does that by [using] non-doctors,’ he said.

‘Nurses go out and make relationships with the patients, understand the patients, understand how they live, what they do, build those relationships and slowly change their social circumstances over time, with the guidance of a doctor overseeing it,’ he said.

He also mentioned that Brazil and India were great examples of using technology in healthcare to reach remote patients and Singapore was an expert on using data to improve health outcomes.

He also highlighted examples of integrated care, with an equivalent of PCNs in the Netherlands, and Kenya where providers, commissioners and industry come together to talk about solutions and how things can be done differently.

‘We can learn from what happens across the world and think smaller and say, how does that apply to me?,’ said Dr Eggitt. ‘Within the time constraints, the finances and  the knowledge that you have, try to develop a strategy of “this is my problem”. This is how I’m going to solve things. Work with patients to describe what that looks like, and then work with patients and your local providers to say, how are we going to make that happen on the ground?’

Delegates were also taken on a tour of primary care closer to home in Greater Manchester where deputy chief executive of the integrated care board (ICB), Professor Colin Scales, spoke about the Blueprint for primary care in Manchester, a five-year plan with the ‘left shift’ towards prevention ‘at the heart’.

He suggested that the ICB has worked to give primary care ‘prominence’.

‘I think we found a position for clinical leadership in Greater Manchester (GM) around primary care that backs the prominence with which we’re giving primary care collaboration and the scale across GM that things can change,’ he said.

‘As well as practice-based leadership and PCN leadership, we have multiple opportunities for GPs and other primary care colleagues to engage in service level leadership, functional leadership within the ICB in place and neighbourhood level, and that’s very important to all of us sitting on the ICB if we’re going to take any of this ambition forward.’

Pulse PCN Events will be heading to London next for our final conference of the year. To register for your nearest event, click here.